Health care in danger: today's Solferinos

20-07-2012 Interview

Just over 153 years ago, Henry Dunant, the founder of the ICRC and the Red Cross / Red Crescent Movement, came across the battlefield outside the northern Italian town of Solferino, where thousands of soldiers lay dead or dying. A century and a half later, too many people are still struggling to access health care in armed conflicts and other emergencies. Paul-Henri Arni, head of the ICRC Health Care in Danger project, elaborates on today's Solferinos and why violence against health care must be stopped.

Would the Red Cross and Red Crescent Movement's founder, Henry Dunant, be satisfied with the state of health care in today's armed conflicts?

He probably would be amazed to see courageous Red Cross and Red Crescent volunteers bringing medical assistance under fire, evacuating the wounded across front lines and even running clinics or hospitals in war zones. But at the same time, he would be appalled to hear that health structures, health staff and ambulances are in the line of fire. He would also be appalled at the news that patients are prevented from safely reaching clinics and doctors get arrested and sometimes killed just for performing their vital job and considering nothing but patients' medical needs.

How has armed conflict changed and what does it mean for health care?

Conflict and armed violence take more and more space in urban and populated settings. When the fighting starts, access to health care becomes a vital issue for people who are sick or wounded. Often access is delayed or made impossible by endless obstruction such as an ambulance held up at a checkpoint.

Many conflicts have generated discrimination against people who are trying to access health care, based on their ethnic or religious origin. This goes straight to the heart of medical ethics: you don't ask wounded people which side, ethnic group or religious confession they are from when they are losing blood. You just treat them, period.

In rural areas, additional obstacles to health care claim many lives where lack of safety and conflict prevail: lack of transport, looting of health centres, among others.

What are the main obstacles to health care being delivered safely?

Firstly, direct attacks against health facilities, patients, staff and medical transport. When a local doctor is killed in Libya or when an ICRC health manager is murdered in Pakistan as happened recently, thousands of patients are deprived of adequate treatment.

Secondly, obstruction of ambulances, patients or health staff at checkpoints for endless hours or days, as happened in 2009 in Gaza, results in wounded people dying while waiting to be evacuated.

Thirdly, discrimination often kills. I recently heard Red Cross doctors from Côte d'Ivoire and Libya describing how their car was stopped to prevent patients from another ethnic group reaching hospital. In the case of Libya, seriously wounded patients belonging to the other side were simply shot in their hospital beds.

And finally, armed entry into health facilities is a serious threat to the safe delivery of health care. The health centre that receives these 'visits' is at risk of losing its medical sanctity in the eyes of the other side to a conflict. This can often result in military strikes against these structures, perceived as having become military targets, as happened in Afghanistan. Armed entry is not illegal, but must be regulated more closely. Armed forces and armed groups must not put patients and staff at risk by their mere presence.

What can be done to remedy this situation?

Violence preventing the delivery of health care is primarily a security rather than a health problem. It is vital to engage with the military, with armed groups, with States, with the health community and with Red Cross and Red Crescent partners to find practical solutions to this important humanitarian concern.

Together with Red Cross and Red Crescent colleagues, we have launched a four-year global initiative to promote the identification and implementation of practical measures to improve the security and delivery of health care in armed conflicts and other emergencies.

The ICRC and Red Cross / Red Crescent National Societies have begun consultations with States and other stakeholders and will involve experts from around the world in ten expert workshops during 2012 and 2013. These workshops will produce practical recommendations and measures, which can be implemented nationally to tackle many of the humanitarian problems identified. This process is geared towards decisions and measures, which can be taken in each country, and really make a difference.

Wars are bad enough; let's at least ensure that all measures are taken to minimize the negative impact on people needing health care.